Socioeconomic Status and Lifestyle Behaviours in Cancer Survivors: Smoking and Physical Activity

Purpose: Smoking cessation and increased physical activity (PA) have been linked to better outcomes in cancer survivors. We assessed whether socioeconomic factors influence changes in those behaviours after a cancer diagnosis. Methods: As part of a cross-sectional study, a diverse group of cancer survivors at the Princess Margaret Cancer Centre (Toronto, ON), completed a questionnaire about past and current lifestyle behaviours and perceptions about the importance of those behaviours with respect to their health. The influence of socioeconomic indicators on smoking status and physical inactivity at 1 year before and after diagnosis were assessed using multivariable logistic regression with adjustment for clinico-demographic factors. Results: Of 1222 participants, 1192 completed the smoking component. Of those respondents, 15% smoked before diagnosis, and 43% of those smokers continued to smoke after. The proportion of survivors who continued to smoke increased with lower education level (p = 0.03). Of the 1106 participants answering PA questions, 39% reported being physically inactive before diagnosis, of whom 82% remained inactive afterward. Survivors with a lower education level were most likely to remain inactive after diagnosis (p = 0.003). Lower education level, household income, and occupation were associated with the perception that PA had no effect or could worsen fatigue and quality of life (p ≤ 0.0001). Conclusions: In cancer survivors, education level was a major modifier of smoking and PA behaviours. Lower socioeconomic status was associated with incorrect perceptions about PA. Targeting at-risk survivors by education level should be evaluated as a strategy in cancer survivorship programs.